CERTIFICATE OF LIABILITY INSURANCE (2)P52(ANRtilM12 .
— �s:,.«
y ACD � D03/2Q/2014Y)
� CERTIFICATE OF LIABILITY INSURANCE
�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGNTS UPON THE CERTIFICATE HOLDER. THIS
CERT�FICATE DOES NOT AFFIRMATIVELY OR NE6ATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate hoider is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain poticies may require an endorsement. A statement on this certificate does not confer rights to the
certiflcate holder in lieu of such endorsement(s).
PRODUCER 1-813-229-8021 CONiACT DidnB Defreeuw
NAME:
H. 8. Wileon Co., Inc. PHONE �F�
(ac,No,Ex�): 813-229-80ai , �ac,r+o�:
300 W. Platt St. E-MAIL ddefreeuwCimewilson.com
ADDRESS:
sce zoo
T8IDp8� FL 33606 INSURER�S) AFFORDING COVERAGE , NAIC k
INSURED
TLC Diveraified, inc.
2719 17th Street Sast
Palmetto, FL 34221
INSURER A : �STFIELD INS CO
INSURER B: FCCI INS CO
INSURER C :
INSURER D :
INSURER E :
24112
'10178
COVERAGES CERTIFICATE NUMBER: 3e9iz9ia REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY RE�UIREMENT, TERM OR CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR�, ' POUCY EFf �' POLICY EXP LIMITS
LTR TYPE OP INSURANCE POIICY NUMBER . MMIDDIYYYY MMIODIYYYY �
A GENERALLUBILm ' I !TRA3972460 04/Ol/1� 04/Ol/15 EACHOCCURRENCE S 1,000,000
�, X .. I �,. '�, � I DAMAGE TO RENTED 500 � 000
COMMERqAL GENERAL LIA8ILITY �: ' !I PREMISES (Ea occurtence) ��� $
�'� ' CLA�MS-MADE � x �� OCCUR �� II ��, I, �'� MED EXP (Any one person) '� a 10, 000
% Contractual Liability I 1,000,000
�� � � � PERSONAL 8 ADV INJURY 3
'�� 8 �� $500 PiOp IIGg DBd �''�, �I Ii • �^ I ! � GENERALAGGREGATE �� $ 2�000,000
A K 0 3.2014 , 2, 000, ooa
�� GEN'L AGGREGATE LIMIT APPLIES PER: II I , ��'�� PRODUCTS - COMP/OP AGG '$
' POLICY I x '. PRO- �� X ' LOC �� ' ' ' ' $
a'� AUiOMOBILELIABILITY ' '� '�,TRA3972460 �I O4/Ol 1� 04/O1/15���. COMBINEDSINGLELIMIT 1,000�000
��, � , I, (Ea accitlenl) , $
', X'�� ANY AUTO � �I ���I .. �'�. BODILY INJURY (Per person) �. E
��� '�. ALL OWNED ' ' SCHEDULED � '. � BODILY INJURY (Per accident) �� $
' ��� AUTOS �� AUTOS '� i
� �'�� NON-OWNED ' �� �i i ��� PROPERTY DAMAGE � $
�! x� HIRED AUTOS X � AUTOS , II �i ,, � �, {Per accidenQ �,
. . , . ,. i �� � , ;
� g 'UMBRELU uAe X 'OCCUR , ' 'TRA3972460 � 04/O1/14 04/O1/15',EACHOCCURRENCE $ 5,000,000
'�, I, EXCESS LUB �� .. CLAIMS-MADE ��, I '�, ��� AGGREGATE �, $ 5, 000, 000
�' � DEO X ��.. RETENTION $ � �'� �� ' � '�.� �,�' ' $
I WORKERSCOMPENSATION � ' � 04/Ol/15' X WCSTATU- �� .OTH-
g, i i001WC13A61661 �', 04/Ol/lq T9RYUMIT$' ' ER .
AND EMPLOYERS' LIABILITY �
', ANY PROPRIETORIPARTNEfLEXECUTIVE Y/ N�� �� �i ��I I EL EACH ACCIDENT �� $ 500, 000
OFFICERIMEMBER E%CLUDED? � �, N / A ; ' ' '
�, (Mandatory in NH) � ��II �� �'. EL. DISEASE - EA EMPLOYEE $ 500, 000
'�. If yes, describe under � ���
'� DESCRIPTION OF OPERATIONS below ' ' II I � � El. DISEASE - POLICY LIMIT ��. $ 500, 000
11 ,Inetallation Floater ; TRA3972460 , 04/O1/1 04/O1/15;$1,000 Ded 1,000,000
� i I I �, Tranait & Storaqe: Included
' � � '�Deductible: 1,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anach ACORD 701, Additional Romarks Sch�dula, if more space is rpuind)
Certificate Holder Liated ae Additional Insured
Lift Station 32 Imyrovements 11-0062-UT
TLC Job # 13-10-01
of Clearwater
P.O. Box 4748
, FL 33758-4748
ACORD 25 (2010105)
cvoi
3e9ia9ia
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
USA I ✓ � ����
O 1988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
�
,.�u.
0
N
w
O
v
N
a
>
z
W
--�.:�- ���-�—��--�-. Cs��� -�c ��` Q C�
� � n�